Doppler ultrasonography

ABCIC

Review Article

My Approach to Coronary Flow Assessment With Transthoracic Echocardiography

José Maria Del Castillo et al. Issam Shehadeh

Abstract

The assessment of coronary flow reserve is an extremely important step in stress echocardiography, both within and outside the context of coronary artery disease. For some, it is seen as an impossible parameter; for others, it is essential. In any case, everything begins with the proper visualization of the coronary arteries at rest. In this article, we will address theoretical and practical concepts for incorporating coronary flow study into the routine of the echocardiographer.

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Case Report

Dorsalis Pedis Artery Aneurysm: an Ultrasound Diagnosis

Ana Claudia Gomes Pereira Petisco et al. Larissa Chaves Nunes Carvalho Mohamed Hassan Saleh Fabio Henrique Rossi … Marcela da Silva Dourado Juliana Chen Heraldo Antonio Barbato Andrea de Andrade Vilela

Discussion

The DPAA (pedal artery) was first described in 1907. Since then, other authors have reported this rare type of aneurysm, but its clinical manifestations are still relatively unknown. With only 24 cases reported in the literature until 2017, according to Aragão et al., the DPAA aneurysm is more common among men (63%) with a mean age of 55.4%. In general, it appears as a pulsatile mass, which may lead to microembolization, hemorrhage, rupture, and nerve compression. Physical examination usually reveals a pulsatile mass that can cause pain, paresthesia, and discomfort when walking or wearing shoes, complaints similar to the case reported in our study.

The pathophysiology of these aneurysms is still uncertain, but it appears to be related to two types of mechanisms: an intrinsic mechanism, related to weakness in the vessel wall structure, such as collagen diseases, Marfan and Ehlers-Danlos syndromes, syphilis, diabetes, infections, trauma, atherosclerosis, and fibrodysplasia; and an extrinsic mechanism, caused by mechanical stress on the arterial wall, such as trauma.^– However, according to the literature, many DPAAs are pseudoaneurysms and occur after trauma or iatrogenic injuries secondary to orthopedic or vascular procedures. Although trauma is a cause of DPAAs, patients are often unable to remember the acute event, and symptoms arise when they experience a compression of local structures or specific events, including embolism or rupture. There have also been cases of repeated, low-impact trauma that have led to aneurysmal degeneration, such as tight shoes in patients with congenitally markedly high arches.

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ABCIC

Review Article

My Approach to Estimate Pulmonary Pressures: Practical Aspects

Halsted Alarcão Gomes Pereira da Silva et al. Helder Moura Gomes

Abstract

Pulmonary hypertension (PH) is a global disease and is increasingly present in echocardiography laboratories, given the progressive rise in its prevalence with population aging. Previously diagnosed only through invasive methods, echocardiographic assessment of pulmonary pressures has become fundamental in screening and monitoring patients with PH. This topic was revisited by the American Society of Echocardiography in a new guideline published in March 2025, reinforcing the importance of echocardiography in clinical stratification, considering recent updates in the definition of PH. Among the main assessment parameters, systolic pulmonary artery pressure, mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and pulmonary capillary pressure (PCP) are described, along with a series of precautions for the correct estimation and interpretation of these values. The classification of PH levels has also been revised in a new framework. As an accessible and reproducible method, the assessment of pulmonary pressures through echocardiography stands out as an essential tool in the evaluation and follow-up of PH.

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ABCIC

Case Report

Behcet’s Disease with Vascular Involvement: Case Report

Isabela Rodrigues Tavares et al. Maria Cristina Miranda Ana Claudia Gomes Pereira Petisco Daniela Souto Barros … Caio Buscatti Folino Vitor Leonidas Boher Dornas Mohamed Hassan Saleh Fábio Henrique Rossi Raquel Peres Sousa Larissa Chaves Nunes Carvalho

Clinical case

Male patient, 34 years of age, previously healthy, admitted to the Emergency Room (ER) of Instituto Dante Pazzanese de Cardiologia reporting a 3-month history of pain in the right lower limb (RLL) and limping for distances of 100 meters in the 3 weeks prior to admission. The patient evolved with worsening pain in the right calf and spontaneous pulsatile bulging a week before admission. He mentioned the use of Rivaroxaban for deep venous thrombosis (DVT) in the RLL five months before, weight loss (15kg in 6 months), and appearance of aphthous lesions in the oropharyngeal region. He had a vascular ultrasound image from another service, with signs of DVT in a partially recanalized right popliteal vein.

On the occasion of admission, physical examination indicated: posteromedial pulsatile mass on the right leg and present pulses, except posterior tibial. Heart, lungs, abdomen, and left lower limb (LLL) without alterations.

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ABCIC

Case Report

Use of Color Doppler of Carotids in the Diagnosis of a Patient with Direct Carotid-Cavernous Fistula

Mauro de Deus Passos et al. Isabella Godoy-Gomes Mariana de Gregório Faria

Abstract

An 18-year-old patient developed a direct carotid fistula after a mild craniocerebral trauma. The patient presented with tinnitus and exophthalmia, both pulsatile and on the left. A carotid Doppler study revealed high blood flow velocities and reduced resistance rates in the left internal and common carotid arteries compatible with a direct carotid fistula. Computed tomography angiography of the brain confirmed the carotid fistula. The patient was successfully referred for endovascular embolization treatment. This case demonstrates that carotid Doppler may play an important role in the diagnosis of direct carotid fistulae and the follow-up of patients undergoing endovascular therapy.

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Artigo Original

Prevalence and correlates of vascular disease at ultrasound examination in patients on hemodialysis

Sebastião Baptista Miguel et al. Jair Baptista Miguel Luis Guilhermo Velarde Elisa de Albuquerque Sampaio … Jorge Paulo Strogoff de Matos Jocemir Ronaldo Lugon

BACKGROUND: Patients on hemodialysis present an increased risk of cardiovascular death. Intimal media thickness (IMT) and presence of arterial calcifications are well-known risk factors for cardiovascular death in hemodialysis patients. OBJECTIVE: To assess the prevalence of IMT and arterial calcifications in HD patients and to correlate image findings with clinical and laboratory data. METHODS: Cross-sectional study involving 75 patients on dialysis for >12 months. Patients underwent B-mode ultrasound scan (US) for determination of IMT of the distal third of the common carotid arteries. Arterial calcifications were assessed by US of carotids, femoral and tibial arteries, and labeled positive if calcification was found in any arterial site. RESULTS: Patients were 52±13 years old, 57% were males and 16% were diabetics. IMT > 0.9 mm was found in 57% of cases and arterial calcifications at US in 48%. Aging (decades) and smoking were associated with both increased IMT (adjusted odds ratio [aOR] = 3.4, p < 0.001; aOR = 4.4, p = 0.045, respectively) and presence of vascular calcifications (aOR = 3.0, p < 0.001; aOR = 6.8, p = 0.011, respectively). High intact parathyroid hormone levels (per each 100 pg/ml) were significantly associated with increased IMT (aOR = 1.7, p = 0.021), but not with vascular calcification. In contrast, Diabetes and time on dialysis (years) were significant determinants for calcifications at US (aOR = 15.0, p = 0.009; aOR = 1.39, p = 0.020), but not for increased IMT. CONCLUSION: Increased IMT and calcifications at US are common findings in hemodialysis patients. Aging and smoking are consistent determinants for both image alterations. Parathyroid hormone elevation is associated with increased IMT. Diabetes and time on dialysis substantially increase the risk for arterial calcification.

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My Approach to Coronary Flow Assessment With Transthoracic Echocardiography

Abstract

Dorsalis Pedis Artery Aneurysm: an Ultrasound Diagnosis

Discussion

My Approach to Estimate Pulmonary Pressures: Practical Aspects

Abstract

Behcet’s Disease with Vascular Involvement: Case Report

Clinical case

Use of Color Doppler of Carotids in the Diagnosis of a Patient with Direct Carotid-Cavernous Fistula

Abstract

Prevalence and correlates of vascular disease at ultrasound examination in patients on hemodialysis

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